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Loss of voice. Lesions of larynx and lungs. Abscesses death mayoccur suddenly and remotely from one of the sequelæ 741in the treatment of strangulation the first indication obviouslyis to remove the pressure from the neck artificial respiration willprobably be required, and may be aided by ammonia applied to thenostrils, tickling of the fauces, and galvanism colin742 statesthat artificial respiration is useless after cessation of heart-beat see the treatment by galvanism under “suffocation ” if the body iscold, artificial heat by means of hot bottles, etc venesection may benecessary colin strongly advises venesection to relieve the distentionof the heart stimulants and light food are often required limousin743 recommends the use of oxygen cobos744 experimented onanimals by injecting oxygen hypodermically, as a means of artificialrespiration his conclusions are that the oxygen is absorbed and carbondioxide eliminated in the same place the oxygen thus introduced causesno trouble testevin745 cures asphyxia by hypodermic injection ofether the after-treatment will depend on the after-conditions the prognosis is good if there is no serious injury to the neck andtreatment is promptly applied post-mortem appearances the post-mortem appearances in strangulation are external andinternal the external appearances are of two kinds. Those directly due toviolence and accident and those due to asphyxia external appearances directly due to violence or accident - the markson the neck in essay fatal paper there are either no marks at all orthey are but slight. This is more likely to be the case in suicidesthan homicides, and is usually due to the ligature being soft andyielding the victim of a homicide may, however, first be stunned andafterward strangled marks are said to be plainer after the body has become cold and wheresubjects have recovered from attempts at suicide the marks of the ligature in strangulation usually encircle the neckmore completely and more horizontally than in hanging these conditionsmay, however, be reversed, because a body may be dragged by the neckafter strangulation, and there have been suicides by hanging in whomthe mark of the cord was horizontal as a rule, however, a horizontalmark with the knot on the same level as the cord, especially if belowthe larynx, suggests strangulation rather than hanging. And if thereare several marks the probability is even greater in compression withthe fingers the marks are not in a horizontal but oblique line the mark of the ligature is usually circular, well defined, andcorresponds closely to the breadth of the ligature. Rather depressed, and usually below the larynx as a rule this depression is not deep;the skin at the bottom of the groove is usually very pale, while theadjacent writings are red or livid essaytimes the bottom of the grooveshows ecchymoses neyding746 says that suggillations in the groovemade by the ligature on the neck are rare, but are oftener found instrangulation than hanging, because the conditions favoring theirformation are oftener found in strangulation in most paper the skinand connective tissue of the groove and of the writings in the vicinityshow, microscopically, hyperæmias and hemorrhages liman747 statesthat when we find suggillation in the groove or its vicinity, we mayknow that essay other form of violence has been applied at the same timeas that of the ligature or hand he had not seen suggillation in thefurrow either in strangulation or in hanging, except when the injuredpersons had lived essay time, and in paper of twisting of the umbilicalcord the absence of suggillation and ecchymosis was due, he thought, to the pressure on the capillaries bremme748 says that in thesubcutaneous connective tissue of the mark of the ligature there is nohemorrhage either in strangulation or hanging, if death occurs at onceand the cord is removed at once after death.

Thymustablets-armour as a matter of record, the descriptive articles for pineal gland, redbone-marrow and thymus gland, which appeared in new and nonofficialremedies, 1918, are given below pineal glandthe functions of this gland have not yet been established but thereis essay pathological and essay experimental evidence that there isa relation between the gland and essay processes of development andgrowth. The nature of this relation is unknown adiposis is a frequentsign of disturbed pineal function, but observers are not agreed whetherto interpret this as indicating hypofunction or hyperfunction, orpossibly a concurrent disturbance of the pituitary in essay instancesintravenous injections of pineal extract have seemed to cause adistinct fall in blood pressure it has been inferred from observationsin paper of pineal tumors in the young that the gland in youngindividuals furnishes a secretion which inhibits growth, writingicularlythe development of the reproductive glands, but the results ofexperimental administration of pineal substance orally have led otherobservers to infer that the pineal secretion favors physical andpossibly mental and sexual development it has been suggested that, asall evidence points to the fact that the function of the pineal glandis one of early life, extract of adult pineal glands might be expectedto be inert experiment has also indicated greater activity in glandsobtained from young animals than in those obtained from older ones thecouncil has decided to admit preparations of pineal gland to new andnonofficial remedies simply for experimental purposes red bone-marrowred bone-marrow consists largely more than 90 per cent of fat innew-born animals a third or more of this fat consists of lecithin the marrow of the bones of new-born animals contains iron up to 1per cent or more in various forms of organic combination bothlecithin and iron decrease rapidly in the first weeks after birth the commercial preparations contain very variable amounts of theseconstituents actions and uses -- red bone-marrow is supposed to stimulate theformation of red blood corpuscles. Whatever action it may have in thisdirection is probably due largely to the iron and lecithin which itcontains it is said to be useful in simple and pernicious anemias thymus glandlittle is known as to the functions of the thymus, but it is believedto have an important relation to growth there also seems to be essayrelation between the thymus and thyroid, for the former is frequentlyabnormal in diseases involving the latter hyperthyroidism the use of thymus is purely empirical it has been employed in thetreatment of hyperthyroidism, rickets, tuberculosis, hemophilia, andinfantile marasmus and atrophy. Its use in the latter conditionsis said to be the most promising it is claimed on very doubtfulgrounds to exert a essaywhat favorable effect in certain paper ofcancer -- from reports of council on pharmacy and chemistry, 1918, p 69 piperazine and lycetol omitted from n n r report of the council on pharmacy and chemistrythe following report explaining the omission from new and nonofficialremedies of piperazine and lycetol has been authorized for publication w a puckner, secretary piperazine diethylenediamene and lycetol a methyl derivative ofdiethylenediamene were accepted for new and nonofficial remedies in1906 both piperazine and lycetol were asserted to be efficient uricacid solvents and efficacious remedies in the treatment of gout andrheumatism these products have been retained until now because therewas no investigation which definitely showed their uselessness as uricacid solvents, though their use is generally admitted to have beendisappointing from an exhaustive and critical study of the available evidence, hanzlik jour lab & clin med , february, 1917 concluded thatscientific evidence, though limited, and clinical opinion indicate thatpiperazine is valueless in gout and that there is sufficient scientificevidence to indicate the worthlessness of lycetol the referee in charge of piperazine and lycetol recommended that theseproducts be omitted from new and nonofficial remedies for the reasonthat they have been sufficiently tried to justify the conclusion thatthey are not of value the period of acceptance having expired, thecouncil directed that piperazine and piperazine tablets the bayercompany, inc and lycetol the bayer company, inc be omitted fromnew and nonofficial remedies -- from reports of council on pharmacyand chemistry, 1918, p 70 stanolind liquid paraffin omitted from n n r report of the council on pharmacy and chemistryas explained in the report which follows, “stanolind liquid paraffin”was omitted from new and nonofficial remedies at the request of theproprietors announcement of this omission was made in the preface tonew and nonofficial remedies, 1918, but publication of the councilreport was postponed pending actual conflict with the rules thecouncil now authorizes publication of the report because a circularindirectly advertising the product to the public was found enclosedwith the trade package of stanolind liquid paraffin w a puckner, secretary stanolind liquid paraffin was admitted to new and nonofficial remediesin 1916, when its method of marketing conformed to the rules of thecouncil this brand of liquid petrolatum, by action of the council, has been omitted from new and nonofficial remedies on request of thestandard oil company of indiana, its manufacturer, who wrote to thesecretary of the council stating that. “in order that our facilities for the manufacture of this oil shall be constantly engaged, it will be necessary for us to find sales on a larger scale than in the past to do this under our present advertising and marketing arrangement we feel will be impossible ”this letter, in addition, suggested “that physicians are notprescribing stanolind liquid paraffin in any considerable proportionof their orders” and “that the situation which now confronts us wouldnot be materially helped if stanolind was specified in all suchprescriptions ” further, the council is asked to consider whetherit “might be willing to declare this preparation as not a councilproduct, ” on the alleged grounds that “liquid paraffin is not medicinalin its action and passes through the digestive tract in practicallyunaltered condition ”the council holds that stanolind liquid paraffin is a drug, and that, therefore, its direct advertising to the public is in contraventionof the council rules constipation should be treated by dietaryand hygienic means evacuants are only temporary measures liquidpetrolatum is medicinal. It greatly modifies the intestinal flora. Itacts as a lubricant and emollient. It modifies the absorptive powersof the intestinal mucous membrane.

“i have found out byactual tests that the preparation maintains its stability for five orsix months ”here are the claims in detail. “for the source of secretin i preferably use that writing of the alimentary tract of any lower animal-- such as a hog or sheep-- including the gastric pylorus, the duodenum and the jejunum this writing is split open and washed with a normal saline solution to clean the mucosa or mucous membrane of any detritus which may be present the mucosa with the epithelial cells is then removed or separated from the muscular wall by scraping with a blunt knife or in any other suitable way the scrapings or cuttings, which contain the secretin, are then macerated or broken up ” “the macerated mass is placed in a suitable vessel and subjected to the action of an acid solution until digested the time for the digestion of the mass will, of course, depend upon the strength and temperature of the acid solution employed the stronger the solution and the higher the temperature, the shorter the time necessary for complete digestion this period may vary from several minutes to several hours in my experiments i found that the best results were obtained with hydrochloric acid solution of one-tenth to five-tenths of one per cent in strength, although as high as eight-tenths per cent might be used the mixture is brought to a temperature of approximately 210 f , and it may even for a few moments exceed that temperature, but it should be kept below the boiling point, for excessive heat injures or breaks down the secretin molecule and impairs or destroys its activity although i prefer to use hydrochloric acid, i would have it understood that other acids-- both organic or inorganic-- may be employed, provided that the percentage of acidity is regulated to prevent a chemical change in the secretin, and further provided, of course, that the acid has no injurious effect on the human system ” “after the mass has been digested in the heated solution, the decoction is decanted, and after being allowed to cool is passed through a suitable filter until the filtrate is clear i found that by filtering the decoction from four to six times through a carbon filter, i obtained a clear colorless filtrate this is a solution of secretin and the acid which was used, and the clearness of the solution shows that it is practically free from albumoses, gelatin and other impurities such as cell tissues, etc present in the raw material under treatment ” “to the solution of pure and active secretin prepared as above explained, there is added a suitable quantity of blood serum-- say from one-fifth to two per cent or any equivalent medium-- such as albumin solution or a peptone solution-- which will aid and sustain the activating power of secretin as provided by the blood that is to say, any medium having the same power, similar quality or chemical composition that the blood-stream possesses in combining with secretin to stimulate the pancreas the addition of such a medium to the active secretin solution increases the potency of the secretin and its degree of stability by preventing oxidation or deterioration thereof if this strengthening or fortifying medium, as it may be properly termed, is alkaline, it performs the additional function of lowering the acidity of the secretin filtrate it is preferable that the final product be just faintly acid if desired, the final product may be made into an elixir by the addition of aromatics ” “any desired strength of secretin solution may be obtained according to the quantity of acid solution in my experiments i used from ten to fourteen duodena to a pint of acid solution ” “the solution of secretin prepared as above described is characterized by its ability to resist oxidation or deterioration for a sufficient period of time to render the solution available as a commercial article, and is furthermore characterized by freedom from poisonous and irritable chemical substances, whereby the secretin is chemically adapted to the human system to stimulate the pancreas to increased secretion ” “as previously stated, the secretin prepared according to my method may be administered orally to produce the desired physiological action of course, if desired, the secretin might be injected intravenously, but this more or less dangerous procedure is not at all necessary, and i merely mention it here to point out that when i refer to the oral administration of my new secretin preparation, i do not mean to exclude its administration by injection ” “as to the commercial stability of the secretin prepared according to my method, i may say that i have found by actual tests that the preparation maintains its stability for as long a period as five or six months when i refer to my product as being “commercially stable, ” i mean that it resists oxidation or deterioration for a sufficient period to render the same available as a commercial article this period may vary from several weeks to several months, depending upon certain commercial factors well understood by the manufacturer so, roughly speaking, i should say that secretin is commercially stable when it retains its activity from one to six months i do not wish to be understood, however, as limiting myself to these exact figures ”that active secretin may be extracted from macerated intestinal mucosaby weak acids below the temperature of boiling is well known in fact, weak acids at body temperature in contact with the duodenal mucosa leadto the formation of secretin the claims that secretin given by mouthreaches the blood and acts on the pancreas has been made for otherpreparations of secretin it has also been shown that these claims areerroneous 122 thus it would appear that the only novel element indr beveridge patented secretin is the addition of serum, solubleproteins or peptones what reason is there for believing that thiswill render the secretin stable for months, and physiologically activewhen taken by mouth?. we do not believe dr beveridge ever injected hissecretin-- protein mixture-- intravenously in man or animals not underanesthesia, otherwise he would not have stated. “of course, if desired, the secretin may be injected intravenously ”122 carlson, lebensohn and pearlman, the journal, jan 15, 1916, p 178 beveridge patented secretin is not stablei the samples of secretin sent us by dr beveridge -- physiologicaltests were made on four quart bottles of the secretin kindly sent us bydr beveridge june 26, 1916 according to a letter from dr beveridgeof july 20, 1916, those samples of secretin were prepared june 20, thatis, only six days before received by us the material came in darkcolored bottles it was kept in the original bottles and placed inthe ice box immediately on receipt dr beveridge stated the secretin“should remain active until the month of november, 1916, at least ”tests were made on three out of the four bottles the fourth bottlewas not opened, as we desired to learn what change it might undergoin the way of protein precipitation and bacterial decomposition there is nothing in the beveridge method of preparation that insuresa sterile secretin unless it is passed through a berkefeld filter in all our crucial experiments the animals dogs were kept underlight ether anesthesia, a cannula inserted into the pancreatic duct, the blood pressure recorded from the carotid artery and the varioussecretin preparations injected intravenously when inactive secretinpreparations were encountered, control tests were always made withactive solutions of secretin to eliminate possible individualpeculiarities of the animal thus when the pancreas of a dog reacts tothe injection of preparation a, but not to preparation b, it isevident that absence of response to b is due to this preparation andnot to the animal or to the experimental conditions illustration. Fig 1 -- records of carotid blood pressure and secretionof pancreatic juice on intravenous injection of beveridge secretinin dogs x, injection of 10 c c secretin. B, record of flow ofpancreatic juice in drops tracing a, injection of 10 c c of onesample secretin ten days old furnished by dr beveridge tracingb, injection of 10 c c of second sample of secretin ten daysold furnished by dr beveridge tracing c, injection of 10 c c of secretin twenty hours old made by us according to the beveridgemethod showing that the secretin preparations sent us by dr beveridgecontained no secretin each of the three samples of secretin sent us by dr beveridge wastested in the above manner on five dogs the first tests were madejune 27, 28 and 29, respectively, that is, within nine days of thepreparation of these samples of secretin none of the samples wasactive fig 1, even when injected intravenously in quantities up to50 c c. 40-50 c c of beveridge secretin mixture may kill a dog bytoo great lowering of the blood pressure a good secretin preparationyields a copious secretion of pancreatic juice on intravenous injectionof a few cubic centimeters it is not difficult to prepare a secretin, by the original bayliss orstarling method or by the beveridge method, that retains essay activityfor a longer period than nine days hence we cannot account for theabsolute inactivity of these preparations except on the assumptionthat they did not contain any secretin to start with. That is, faultypreparation and absence of physiologic standardization the sample kept intact in its original container for six months becamegradually cloudy, a large mass of amorphous precipitate settledto the bottom and the odor showed bacterial decomposition it isreprehensible, to say the least, to state concerning such a mixture:“of course, if desired, it may be injected intravenously ” the factthat beveridge secretin may be rendered clear by filtering throughcarbon is not sufficient evidence that it is “pure secretin, ” free frombacteria and other injurious substances ii beveridge secretin mixture is rapidly rendered inactive by humangastric juice -- we prepared active secretin solutions by the beveridgemethod, using 0 2 per cent serum as the protein “stabilizer” ?. the addition of the serum does not appear to affect the activityof the fresh secretin preparation if beveridge secretin is ableto act on the pancreas when given by mouth, it is obvious that itmust run the gamut of gastric digestion, except in paper of completeachlorhydria it has been repeatedly demonstrated that all othersecretin preparations are rapidly destroyed by pepsin-hydrochloric aciddigestion is beveridge secretin an exception?. what is there in alittle serum, native albumin, or peptones to protect secretin againstgastric digestion?. The pure human gastric juice used in these tests was secured fromthe fistula case mr f v that has been under observation in ourlaboratory for years 123123 carlson. The control of hunger in health and disease, chicago, 1916 beveridge secretin and bayliss-starling secretin prepared sept 29, 1916 response of pancreas no of drops of secretin date of test quantity of ┌───────────┴───────────┐ secretin bayliss-starling beveridge injected, c c secretin secretin sept 29 10 75 78 oct 2 10 61 61 oct 6 10 28 17 oct 13 10 25 31 oct 27 10 5 6 nov 3 10 7 6 nov 17 10 4 5 nov 30 10 3 4 dec 4 10 2 2 dec 20 10 0 0 -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- two cubic centimeters of fresh gastric juice added to 8-10 c c beveridge secretin, the mixture being kept at body temperature 38 c , renders the secretin completely inactive in from 5 to 8minutes fig 2 there is no exception to this rule, as we haverepeated the test on thesis different secretin preparations and usingdifferent samples of human gastric juice the secretin of beveridgeis just as vulnerable as the secretin of bayliss and starling topepsin-hydrochloric acid digestion on what kind of tests doesbeveridge base his claim that his secretin mixture acts on the pancreaswhen given by mouth?. Iii the relative rate of deterioration of the secretin solutionsprepared according to bayliss and starling and according tobeveridge -- six different preparations of the two kinds of secretinwere made, kept in dark stoppered bottles in the ice box, and tested byintravenous injection in dogs under ether anesthesia from time to timeuntil all influence on the pancreas had been lost one typical seriesof these tests is given by the way of illustration see table on page126 illustration. Fig 2 -- records of carotid blood pressure and flow ofpancreatic juice on intravenous injection of secretin prepared by usaccording to the beveridge method x, injection of 10 c c of thesecretin. B, record of flow of pancreatic juice in drops tracinga, the 10 c c of beveridge secretin injected had been digested forfive minutes with 3 c c of human gastric juice tracing b, injectionof 10 c c of the same secretin preparation not subjected to gastricdigestion showing rapid and complete destruction of beveridgesecretin by human gastric juice it will be seen that the rate of deterioration oxidation ordecomposition of the secretin is practically the same whether preparedaccording to bayliss and starling or according to beveridge figure 3 in both preparations the rate of deterioration is most rapid the firstfew days after preparation it is scarcely necessary to point out thatsecretin preparations not kept constantly at low temperature and in thedark, as in the above experiments, will deteriorate more rapidly illustration.

Still he should insuch instances use extra means to obtain the services of essay other andequally skilful man only ordinary and usual skill required - the degree and characterof necessary skill contracted for has been variously defined by thecourts when malpractice is discussed, a more extended considerationof this matter will be required at present the doctrine laid downin shearman and redfield on “negligence, ” paragraphs 433-435, may beadopted it is as follows:“although a physician or surgeon may doubtless by express contractundertake to perform a cure absolutely, the law will not imply sucha contract from the mere employment of a physician a physician isnot an insurer of a cure, and is not to be tried for the result ofhis remedies his only contract is to treat the case with reasonablediligence and skill if more than this is expected it must be expresslystipulated for the general rule, therefore, is, that a medicalman, who attends for a fee, is liable for such want of ordinary care, diligence or skill on his writing as leads to the injury of his patient to render him liable, it is not enough that there has been a lessdegree of skill than essay other medical man might have shown, or a lessdegree of care than even himself might have bestowed. Nor is it enoughthat he himself acknowledged essay degree of want of care. There musthave been a want of competent and ordinary care and skill, and to sucha degree as to have led to a bad result but a professed physicianor surgeon is bound to use not only such skill as he has, but to havea reasonable degree of skill the law will not countenance quackery;and although the law does not require the most thorough education orthe largest experience, it does require that an uneducated, ignorantman shall not, under the pretence of being a well-qualified physician, attempt recklessly and blindly to administer medicines or performsurgical operations if the practitioner, however, frankly informs hispatient of his want of skill, or the patient is in essay other way fullyaware of it, the latter cannot complain of the lack of that which heknew did not exist ”164average standard of skill of any professed school must beattained - it is also a rule that one who professes to adhere toa writingicular school must come up to its average standard, and mustbe judged by its tests, and in the light of the present day thus aphysician who would practise the reckless and indiscriminate bleedingwhich was in high repute not very thesis years ago, or should shut upa patient in fever and deny all cooling drinks, would doubtless findthe old practice a poor excuse for his imbecility so, if a professedhomœopathist should violate all the canons of homœopathy, he wouldbe bound to show essay very good reasons for his conduct, if it wasattended with injurious effects upon thesis points of medical andsurgical practice all of the schools are agreed, and indeed commonsense and universal experience prescribe essay invariable rules, toviolate which may generally be called gross negligence yet the patientcannot justly complain if he gets only that quality and kind of servicefor which he bargains if he employs a cheap man, he must expect cheapservice puffendorf, in his “law of nature and nations, ” observes:“we read a pleasant story of a man who had sore eyes and came to ahorse-doctor for relief the doctor anointed his eyes with the sameointment he used among his horses, upon which the man falls blind, and the cause is brought before the judge, who acquits the physician for if the fellow, says he, had not been an ass he had never appliedhimself to a horse-doctor ” see also jones on bailments, 100. 1 field“lawyers’ briefs, ” sub bailments, sec 573. Musser v chase, 29 ohiost , 577. Lanphier v phipos, 8 carr & payne, 478 degree of care and skill used a question of fact - in an actionat law, whether brought by a physician to recover for his services, or by a patient to recover for malpractice or neglect, it is alwaysa question of fact, to be determined by the jury under properinstructions as to the measure of care and skill required, whether ornot the physician has in a given case used that degree of care anddisplayed that amount of skill which might reasonably be expected of aman of ordinary ability and professional skill these same rules applyto the surgeon he must possess and exercise that degree of knowledgeand sense which the leading authorities have announced, as a result oftheir researches and experiments up to the time, or within a reasonabletime before, the issue or question to be determined is made 165rule in leading case of lanphier v phipos - in the case of lanphierv phipos, 8 c & p , 478, already cited, chief justice tyndallenunciated the rule as to the degree of skill required of a physicianor surgeon, which has been followed by all the courts since then hesaid. “every person who enters into a learned profession undertakes tobring to the exercise of it a reasonable degree of care and skill hedoes not, if he is an attorney, undertake at all events to gain thecause, nor does a surgeon undertake that he will perform a cure. Nordoes the latter undertake to use the highest possible degree of skill, as there may be persons of higher education and greater advantagesthan himself. But he undertakes to bring a fair, reasonable andcompetent degree of skill and in an action against him by a patient, the question for the jury is whether the injury complained of must bereferred to a want of proper degree of skill and care in the defendant, or not hence he is never presumed to engage for extraordinary skill, or for extraordinary diligence and care as a general rule, he whoundertakes for a reward to perform any work is bound to use a degreeof diligence, attention and skill, adequate to the performance of hisundertaking. That is, to do it according to the rules of the art;spondet peritiam artis and the degree of skill arises in proportionto the value and delicacy of the operation but he is in no caserequired to have more than ordinary skill, for he does not engage formore ”physician must instruct patient how to care for himself, etc - acorollary of these rules is, that the physician must give properinstruction to his patient how to take care of himself, how to manage adiseased or injured member, when and how to take any medicines that maybe prescribed, what diet to adopt, and that in case the physician failsto give these instructions he is liable for any injuries that resultfrom this failure carpenter v blake, supra patient must inform physician fully concerning his case hiscommunications privileged - on the other hand, as we have alreadystated, the patient owes the duty to his physician of informing himfully of all the varied symptoms of his disease, or the circumstancesattending his injury, and to freely and with due confidence answerall questions concerning his past history which would tend to throwany light upon his present condition to battle with the occultforces which play so important a writing in determining the course orconsequences of disease, it is absolutely essential that the physicianshould know all that is possible to be known of the patient history, and of the history of the patient family as we shall see later on, all such communications are, in most of the states of the union andelsewhere, by statutory enactment made privileged, and without theconsent of the patient the physician or surgeon is absolutely forbiddento divulge any communication or information which he receives in orderto enable him to prescribe this rule applies equally whether thephysician or surgeon is acting for hire or is treating the person as acharity patient, and it has been extended by construction by the courtsin essay states, so as to include examinations made by jail physiciansor other physicians sent by the prosecuting officials of the state toexamine a prisoner, for purpose of giving evidence, but who allowedthe prisoner to suppose that they were there simply to treat him intheir professional capacity people v murphy, 101 n y , 126 atthe same time the courts have been careful to make an exception in thecase of advice given for the purpose of enabling the person receivingthe advice to commit a crime, and of any information received by thephysicians while the persons asking for it were engaged in a criminalattempt all of these interesting questions will be examined andtreated of at length hereafter 166conditions of contract between physician and patient furtherconsidered - it has been observed that the contract between thephysician and patient may be conditional or unconditional by this itis meant that limitations upon the reciprocal obligations between themmay be imposed, or extensions of such obligations made, by specialagreement the physician may contract to cure, and may make the curea condition precedent to receiving any reward for his services ormedicaments, and a breach of such a contract will be enforced bythe courts as a bar to an action for services rendered or medicinesfurnished the patient may agree to come to the physician home or toa hospital or other place agreed upon between them, for the purpose ofbeing treated, or of being operated upon by a surgeon, and a failureto perform such an agreement on the writing of the patient absolves themedical man from carrying out his agreement to treat the patient in the case already suggested of a request by the medical man forinformation as to the patient past history, or that of the patientfamily, or the circumstances concerning the injury or symptoms ofthe disease, if the patient should give false information, or shouldwilfully neglect to give true information, the physician would have aright, upon giving reasonable and due notice, and opportunity to employessay one else, as already intimated, to decline to proceed further withhis care of the case, and might sue and recover pay for the servicesrendered physicians cannot contract that they shall not be responsible forwant of ordinary care and skill - an important and salutary exceptionto the general rule that all writingies may contract freely as betweenthemselves stipulations measuring their reciprocal obligations, doubtless applies to the relations between physician and patient it is an exception which has been applied to the contract relationsexisting between a common carrier and a shipper or a passenger this isthat persons contracting to perform services which are to a certainextent public in their nature, and which, as in the case of the commoncarrier or in the case of the physician or surgeon, are foundedupon conventional relations, and affect the public welfare, are notpermitted, from reasons of public policy, to contract for a release orescape from liability arising out of their own negligence or wrong inshort, a physician or surgeon cannot contract with a patient that thepatient shall waive any claim for damages growing out of his want ofordinary care and skill nevertheless, the physician or surgeon mayfrankly inform his patient of his want of knowledge and experience asto the writingicular kind of treatment required by any special and unusualdisease or injury if after full information on this point, and fullopportunity to employ essay one else, the patient insists that thephysician or surgeon go on with such treatment as he is able to giveto the case, and injuries result which a more skilful and experiencedpractitioner might have avoided, it is probable that the courts wouldhold that the practitioner was not liable under such circumstances, or that such circumstances could be pleaded in mitigation of damages but it would be the duty of the practitioner in such a case to beexceedingly careful in performing any surgical operations, and notadminister any powerful drugs with the strength and medicinal qualitiesof which he was not acquainted if he should assume to perform suchoperations or administer such drugs instead of confining himself tomodifying the ravages of disease by the use of well-known simpleremedies, or protecting against the consequences of severe injury bythe use of ordinary antiseptic dressings and treatment, he would nodoubt be liable for any resulting damage, and could not recover pay forhis service experiments not to be tried on patients this rule applies to charitypatients - for like reasons of public policy it has been held that aphysician has no right to try experiments on his patient 167 in thisrespect a charity patient will be protected by law and compensated fordamages received from experiments on his health and person, just asmuch as a person from whom a large fee could be expected humanity andpublic policy both forbid that experiments should be tried upon oneclass of patients any more than another however this may be, in acase of extreme danger, where other resorts have failed and everythingelse done that could reasonably be required, and if the patient andhis family consent after full information of the dangerous characterof the operation, or the unknown qualities and powers of the drug tobe administered, the practitioner would be justified and protected ifessay new methods of treatment not entirely developed or known to theprofession, but supposed to be efficacious, should be adopted, althoughthe result might prove unfavorable in such a case, however, it wouldbe extremely perilous for the physician to stand upon his own judgmentalone he should consult the best talent in his profession available, and abide by the judgment of his colleagues or a fair majority of them;and even then should apply to his course of action the maxim when indoubt run no risks. Better let a patient perish from disease or injury, than while attempting uncertain experiments with the surgeon knifeor the use of dangerous drugs the safe rule is to take no chances, unless there is a consensus of judgment of several physicians itmay be objected that if no experiments are tried no new medicines orsurgical devices could be discovered, or their effects observed theanswer to this objection is that vivisection, and other experimentsupon live animals, permit of experimentation to a considerable degree, and often effectually point out the proper course of treatment of thehuman subjects in the case of drugs and medicines the practice is wellknown of physicians trying the effects thereof upon their own persons, in their zeal and anxiety to give to the world new discoveries but, as heretofore observed, the law does not recognize the right of themedical or surgical practitioner to tamper with his patients’ health bythe use of untried experiments, without imposing upon the practitionerliability for all injuries proximately resulting from their use allof such matters will, however, fall more properly under considerationwhen the liability of the physician and surgeon for malpractice isconsidered chapter iv of the legal right of physicians and surgeons to recover compensationfor services liability to pay for services - an important matter for physiciansand surgeons is the question as to who is responsible, or liable to payfor their services if there is an express contract this question doesnot arise. But in most instances the person performing the servicesrenders them upon call, and it is necessary for him to understand hislegal right to recover pay for services in the absence of an expresscontract person treated, and not person calling in physician, employs himand is liable - in the first place, it must be stated as a generalproposition that the person for whom the services are actuallyrendered, or upon whom the operation is performed, is bound to pay forthem, if otherwise capable in law of making contracts and incurringobligations and secondly, that one who calls a physician or surgeonto attend a patient is not presumed to have contracted to pay for theservices rendered, unless his relations with the patient are such thathe would be obligated in law to pay, even if he had not himself calledin the medical man in the first case it is presumed that the patient is liable, because hereceives the benefit of the services, and nothing less than a distinctunderstanding that he was not to pay will relieve him from thisobligation married women and infants generally not liable - where such a personis a married woman, unless the case arises in states or countrieswhere married women have been declared by statutes to be liablethe same as if single, this rule does not obtain nor is an infantpersonally liable when he is living with his parent or guardian hullv connelly, 3 mccord s c , 6.

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Or by a bullet in the latter case thecourse and direction of the ball should be ascertained by dissectionrather than by the use of the probe, and the character of foreignbodies, if any are found in the wound, should be noted what nervesor blood-vessels, writingicularly arteries, have been injured, should beascertained it is often important to determine whether a wound wasmade before or after death the following may serve as a differentialpoint. In all wounds made after death there is slight bleeding, non-contraction of the edges, and absence of blood in the tissues thisis the opposite of ante-mortem wounds again, wounds inflicted withintwo hours after death cannot be differentiated from those made duringlife see gunshot wounds, vol i , p 610 et seq. Wounds, vol i , p 476 et seq 5 fractures - if there are any evidences of fractures, thesituation of the bones involved should be noted, and whether theyare accompanied by contusions of the soft writings fractures which areinflicted during life are always accompanied by much more extravasationof blood, more injury to the soft writings, and more evidences of reactionthan those occurring after death it is a well-known fact that it ismuch more difficult to produce a fracture in a dead than a living body see wounds, vol ii , p 482 et seq 6 the temperature of the body should be taken 7 the rigidity and flexibility of the extremities should beascertained 8 the state of the eyes should be noticed, and the relative size ofthe pupils 9 attention should be paid to the condition of the cavities of themouth and nose the neck should be specially examined for marks ofexternal injury, or signs of ecchymosis or compression 10 genitals - the external genitals should be very carefullyexamined for evidence of injury, the presence of syphilitic lesions, and in the female the condition of the vagina should be writingicularlyascertained 11 œdema of the feet - if there is evidence of œdema in any writing ofthe body, especially about the ankles, its situation and extent shouldbe noted 12 ulcers and abscesses - the situation and extent of any ulcerfound on the body should be recorded, as also the presence andsituation of any abscess 13 burns - the extent of a burn, as also the state of the writingsinvolved, should be noted for example, whether they are inflamed orshow blisters, etc see heat and cold, vol i , p 647 et seq 14 hands - in medico-legal paper the hands of a dead person shouldalways be examined for the presence of cuts, excoriations, or foreignsubstances found upon them. Especially should the dorsal extremitiesbe examined this examination will often indicate that there has beena mortal struggle before death the impression of a hand or of essayof the fingers is often found on the skin of a dead body the exactsituation where found should be noted this may be of importance, aswhen it occurs where it would have been impossible or improbable forthe deceased to have caused it for appearances in death from lightning or electricity, see vol i , p 701 et seq , and in death from hanging, strangulation, and garroting, see vol i , pp 713, 746, 781, et seq internal examination having completed the examination of the external writings of the body, thenext proceeding is to open the body and make an internal examination this should be done by following a regular method, so as to examine therelations of writings and not to injure one organ while removing another in opening the various organs an incision should be made which willexpose the greatest amount of surface at one cut never make a numberof small and always unsatisfactory incisions in an organ in openingcertain organs like the brain and heart, the incisions are so plannedthat the writings of the organ may be folded together, and, if necessary, their relations to one another and the whole organ studied such organsare opened as one would open a book to examine its pages it is important to remember that after death the blood leaves thearteries and left side of the heart, and collects in the veins and theright cavities of the heart especially does it collect in the vesselsof the most dependent portions of the body and of the various organs, so that local congestions may often disappear after death.